The gap between charges levied on individuals paying hospital bills through insurance and those paying privately and has been rising steadily for more than twenty years now and we have seen particular divergence since the turn of the century. Indeed, the latest available figures show that private patients were paying no less than two and a half times as much as insured patients in 2004.



The American Hospital Association (AHA), to which the majority of America's approximately 5,000 hospitals belong, disputes this figure and claims that, while there has certainly been a problem in the past, since these figures were issued in 2004 a great deal has been done to solve this problem.

A major part of the argument they use is that there was considerable confusion for a long time about whether or not hospitals could charge patients at different rates and that they have been waiting for guidance from the US Centers for Medicare and Medicaid before they could authorize discounts for uninsured patients.

Well I don't know about you but for this writer that sound like a lot of political hogwash!

The simple fact of the matter is that hospitals, like many businesses, deliberately inflate their charges when drawing up their pricelist (the 'chargemaster' in this case) because they know that the vast majority of their customers are major insurers who are going to negotiate substantial discounts as a condition of approving a hospital for use by their policyholders. This is fine and represents nothing more than normal business practice.

However, in a country with very little state aided healthcare this leaves anyone without insurance paying far more than those people who are fortunate enough to have insurance.

There are currently estimated to be about forty six million Americans without health insurance and without any ability to negotiate for lower hospital charges and, as things stand, it is unlikely that anyone is going to take up the fight on their behalf. Sooner or later of course somebody is going to have to overhaul the healthcare system in the US and hopefully this problem will disappear but, in the meantime, what is the answer?

The only real solution at the moment is, wherever possible, to ensure that you have at least some emergency health insurance cover. Yes health insurance can be expensive, but it is possible to get cover at quite affordable rates if you shop around and the cost of meeting your hospital bills will certainly be a lot less with health insurance than it will be without it.